Li Xiaoya, Hu Tingting, Xu Yiting, Lu Xuhong, Su Yingying, Xiao Yunfeng, Wang Yufei, Ma Xiaojing, Bao Yuqian
Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, 200233, People's Republic of China.
Department of Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, People's Republic of China.
Diabetes Metab Syndr Obes. 2025 Aug 13;18:2863-2872. doi: 10.2147/DMSO.S543163. eCollection 2025.
Obesity contributes to cardiovascular (CV) events. This study aimed to identify the most effective anthropometric indicators that add predictive value to body mass index (BMI) for subsequent CV events in individuals without carotid plaques, improving early risk stratification in subclinical populations.
This longitudinal study enrolled 1043 participants from a community-based cohort in Shanghai (2013-2014) and followed them for CV events through 2021-2022. The CV events included ischemic heart disease (myocardial infarction, unstable angina pectoris, hospitalization for heart failure, and coronary revascularization), ischemic stroke, and CV death. Carotid plaque was excluded via ultrasound. Visceral fat area (VFA) was assessed using magnetic resonance imaging. The neck circumference (NC), neck-to-height ratio (NHtR), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), neck-to-limb length ratio (NLR), and waist-to-limb length ratios (WLR) were calculated.
Multivariable linear regression analysis revealed a significant positive correlation between various obesity-related indices (BMI, waist circumference, NC, NHtR, WHtR, WHR, NLR, and WLR) and VFA (all < 0.001). Over a mean follow-up period of 7.6 years, 97 CV events (9.3%) were recorded. Cox proportional hazards regression demonstrated that elevated NLR was significantly associated with an increased CV risk with hazard ratios of 1.28 (95% confidence interval [CI]: 1.08-1.52). Notably, the NLR significantly improved the predictive capacity of CV events (C-statistic, 0.671 [95% CI: 0.616-0.726], = 0.002; NRI, 0.090 [95% CI: 0.003-0.177], < 0.001; IDI, 0.007 [95% CI: 0.000-0.019], < 0.001).
NLR was correlated with visceral fat content, and significantly enhanced the predictive value of BMI for CV risk in individuals without baseline carotid plaque. These findings support their use in routine clinical assessment to enhance early prevention efforts.
肥胖会导致心血管（CV）事件。本研究旨在确定最有效的人体测量指标，这些指标可为无颈动脉斑块个体的后续CV事件增加体重指数（BMI）的预测价值，改善亚临床人群的早期风险分层。
这项纵向研究纳入了2013 - 2014年来自上海一个社区队列的1043名参与者，并对他们随访至2021 - 2022年以观察CV事件。CV事件包括缺血性心脏病（心肌梗死、不稳定型心绞痛、因心力衰竭住院和冠状动脉血运重建）、缺血性中风和CV死亡。通过超声排除颈动脉斑块。使用磁共振成像评估内脏脂肪面积（VFA）。计算颈围（NC）、颈高比（NHtR）、腰高比（WHtR）、腰臀比（WHR）、颈肢长度比（NLR）和腰肢长度比（WLR）。
多变量线性回归分析显示，各种肥胖相关指标（BMI、腰围、NC、NHtR、WHtR、WHR、NLR和WLR）与VFA之间存在显著正相关（均P < 0.001）。在平均7.6年的随访期内，记录了97例CV事件（9.3%）。Cox比例风险回归表明，升高的NLR与CV风险增加显著相关，风险比为1.28（95%置信区间[CI]：1.08 - 1.52）。值得注意的是，NLR显著提高了CV事件的预测能力（C统计量，0.671[95%CI：0.616 - 0.726]，P = 0.002；NRI，0.090[95%CI：0.003 - 0.177]，P < 0.001；IDI，0.007[95%CI：0.000 - 0.019]，P < 0.001）。
NLR与内脏脂肪含量相关，并显著增强了无基线颈动脉斑块个体中BMI对CV风险的预测价值。这些发现支持将它们用于常规临床评估以加强早期预防工作。
